Shot at a second chance

This story was original published in the March/April 2015 issue of West Virginia Focus magazine.

In late October 2011, storm winds brought down trees all around James Ball’s home near Danville, making the road to his home impassable. It was a terrible time to have a drug overdose.

Ball’s cousin, Delegate Josh Nelson, recently took to the floor of the House of Delegates to recount what happened next. Someone called 911 once it was clear Ball needed medical attention, but paramedics could not make it up the 10-mile-long hollow where he lived. Nelson and his family members tried to cut the trees out of the roadway with chainsaws. They tried to drag the trees out of the way with all-terrain vehicles. But despite their work, the ambulance only made it halfway to Ball’s house.

Desperate, they switched strategies and loaded Ball onto a stretcher, strapped the stretcher to an ATV, and hauled him to the ambulance. “Unfortunately we did not get it there in time and he passed on,” Nelson told his fellow lawmakers. “It was too late.”

Ball battled his addiction to prescription painkillers for years, Nelson says. More than once he started attending church, trying to live right, only to have his demons drag him back to the bottom. “He would kind of get better and do it again,” Nelson says. Ball had overdosed before but was lucky enough to get to a hospital in time for doctors to resuscitate him. On October 28, 2011, his time ran out.

Nelson says Ball probably would still be alive, however, if his family members had access to Naloxone, an “opioid antagonist” medication that oftentimes can save the life of someone suffering from a heroin or painkiller overdose.

The medication, sometimes known by its brand name Narcan, has been on the market for more than 30 years but, until recently, only medical professionals had access to it. During his State of the State address in January, Governor Earl Ray Tomblin vowed to put Naloxone in the hands of both emergency responders and addicts’ loved ones. “By expanding access to this life-saving drug, we can prevent overdose deaths and give those suffering from substance abuse the opportunity to seek help, overcome their addiction, and return to their families, workplaces, and communities,” Tomblin said in the speech.

West Virginia leads the nation in drug overdose deaths, according to a 2013 report by Trust for America’s Health. In 2010 there were 28.9 fatalities per 100,000 people in the state, the highest per-capita rate in the nation. That is also a 605 percent increase over 1999, when the state had just 4.1 overdose deaths per 100,000 residents. Gary Mendell, CEO of the anti-drug lobbying group Shatterproof, says many of those lives could have been saved if Naloxone were more readily available.

Members of the state Senate passed a bill to deregulate the overdose antidote during the 2014 regular session, but the measure failed to gain traction in the House of Delegates. Governor Tomblin’s proposed legislation did not meet the same fate, however. It passed the Senate with a unanimous vote in early February. A little more than a week later, following Nelson’s heartfelt floor speech, it received another unanimous vote in the House of Delegates.

Tomblin signed the bill into law on March 9, so by the end of May state doctors will be able to prescribe Naloxone to drug addicts’ family, friends, and caregivers, as well as police and firefighters. The medicine can be given through a single-use shot, like an EpiPen, or a nasal spray. And while the law also created a limited liability statute for those administering Naloxone, the medicine carries little risk. It’s not even dangerous if given to someone who is not experiencing an overdose. “There’s no negative effects. It’s not addictive. There’s no abuse potential,” Mendell says.

Naloxone works by blocking the receptors in the brain affected by opioids, a category of drugs that includes heroin, morphine, oxycodone, hydrocodone, codeine, and methadone. By blocking the receptors, the medicine temporarily stalls the opioids’ effects on the body. The results usually are immediate. Most overdose victims in respiratory distress begin breathing regularly within minutes of receiving a dose.

The medicine is not without risks, however. It does not work on non-opioid drug overdoses—meaning it would be useless on cocaine or methamphetamine addicts, for instance—and overdose patients still must seek medical attention even if they feel fine after receiving Naloxone. Dr. David Seidler, chairman of Charleston Area Medical Center’s emergency medicine residency program and medical director for the Kanawha County Ambulance Authority, says overdose patients often refuse medical treatment after being revived with Naloxone. “They refuse to go to the hospital because they wake up and they’re feeling fine, or they wake up and they’re pissed off,” he says.

And Naloxone does not always last as long as the opioids it neutralizes. The medication can wear off while the other drugs are still coursing through an addict’s veins. “There’s a risk they’ll become unconscious again and potentially could die,” Seidler says. “Thirty or 40 minutes later, if they had a big enough overdose, they’ll be unconscious again.” If that happens, medical treatment at a hospital is an overdose victim’s best chance at survival.

Rodney Miller, president of the West Virginia Sheriff’s Association, says he’s glad officers will now be allowed to use Naloxone. Police often arrive at the scene of overdoses long before ambulance crews, but since state law limited the medication to medical professionals, “we couldn’t, by law, have Narcan in our possession, let alone administer it,” Miller says.

He says expanding Naloxone’s availability will not solve West Virginia’s rampant drug abuse problems. But, he admits, that’s not the point. “The spirit of this legislation is, if you’ve got a person that’s an accidental overdose, it can save their life and give them a second chance.” It will be up to the addict to decide what to make of his second chance.